As known in the art, the establishment of an adequate airway is oftentimes an essential initial step in the treatment of a patient suffering from a wide variety of diseases or injuries. Generally, the airway is established through an endotracheal intubation procedure, wherein an endotracheal tube is orally or nasally directed into the trachea of the patient. Most commonly, endotracheal intubation is performed with the aid of an ancillary laryngoscope, through which the vocal cords of the patient are directly illuminated and visualized during the tracheal insertion of an endotracheal tube. Unfortunately, conventional orolaryngeal endotracheal intubation is not always possible due to anatomical deviations, trauma to the airway and face, excessive blood and secretions, fractures to the cervical spine, or occlusions of the airway. In such cases, other intubation techniques, such as retrograde intubation or the like, may be utilized to provide a patient with a potentially lifesaving airway.
Retrograde intubation of the trachea, commonly designated as the Seldinger technique, involves the passage of a guide-wire through the trachea of a patient. More specifically, the guide-wire is threaded through a needle puncture site disposed proximate the cricothyroid membrane or cricoid plate of the larynx, and exits through the mouth or nose of the patient after passing through the vocal cords. The distal end of the guide-wire is subsequently passed through the lumen of a conventional plastic endotracheal tube. Using the wire as a guide, the endotracheal tube is directed into the mouth or nose, through the pharynx and vocal cords, and into the trachea of a patient. Thereafter, the guide-wire is removed and the endotracheal tube is secured within the trachea. Unfortunately, although this technique provides an effective alternative for conventional endotracheal intubation procedures, it suffers from several disadvantages.
In order to initiate the procedure, the trachea must be externally punctured with a hollow needle. As known in the art, the initial puncture of the trachea through the cricothyroid membrane requires a substantial amount of pressure. If sufficient care is not taken after the needle has successfully passed through the anterior wall of the trachea, the needle may inadvertently puncture the posterior wall of the trachea, potentially injuring the esophagus, carotid artery, jugular veins, or multiple other nearby organs.
Heretofore, retrograde wire-guided endotracheal intubation has been performed by passing a guide-wire into the lumen of an endotracheal tube through the main beveled end hole thereof, or through an aperture (the "Murphy's eye") disposed on the side wall of the tube. Unfortunately, due to the large amount of "play" afforded by the relatively large diameters of the main beveled end hole and Murphy's eye, the endotracheal tube generally becomes snagged on the epiglottis or vocal cords of a patient during a retrograde endotracheal intubation procedure, oftentimes resulting in local tissue trauma and/or delayed tube insertion.
Finally, retrograde intubation is commonly utilized in emergency situations when other intubation techniques for gaining airway access are unsuccessful or inappropriate. Unfortunately, the performance of this procedure requires the utilization of a variety of devices which are currently not packaged together in the form of a kit. Consequently, when it becomes apparent that retrograde endotracheal intubation is warranted in an emergency situation, there is often insufficient time available to gather the necessary equipment. As such, the establishment of an airway may be adversely delayed, potentially resulting in the death of a patient.